非牵引床下股骨近端防旋髓内钉治疗股骨转子间骨折的疗效研究  

Treatment of Femoral Intertrochanteric Fractures with Proximal Femoral Nail Anti-rotation without Traction Bed

作　　者：鲁成[1] 刘磊[1] 仲文军 陈家麟[1] 项征[1] 杨劲松[1] 薛天乐[1] 侯德胜[1] 吴泉[1] 韩庆[1] 

机构地区：[1]安徽省滁州市第一人民医院骨科,239000

出　　处：《中国全科医学》2016年第B12期6-8,共3页Chinese General Practice

基　　金：2016年安徽省卫生和计划生育委员会科研计划项目(全科医学临床科研课题)(2016QK037)

摘　　要：目的 探讨在非牵引床下采用股骨近端防旋髓内钉（PFNA）治疗股骨转子间骨折的临床疗效。方法选取2013年3月—2016年6月在非牵引床下采用PFNA治疗43例股骨转子间骨折患者。其中男12例,女31例;年龄44-93岁,平均73.9岁。按AO分型：31A2型38例,31A3型5例;改良Evans分型：ⅡA型6例,ⅡB型8例,Ⅲ型29例。观察患者的手术时间、术中总出血量、下床完全负重时间、骨折愈合时间、术后并发症的发生情况。根据Harris髋关节评分标准进行疗效评价。结果 手术时间35-86 min,平均（48±13）min;术中出血量50-180 ml,平均（87±23）ml。43例患者均获随访,随访时间为4-26个月,平均15.6个月;骨折愈合时间为8-15周,平均10周;患者术后可完全负重行走为8-16周,平均12周。其中2例患侧深静脉血栓形成。无感染、髋内翻畸形、股骨头切割及断钉发生。按Harris髋关节评分标准评定患侧髋关节功能,其中优32例、良9例、中2例、差0例,优良率为95.35%（41/43）。结论 PFNA是治疗不稳定型股骨转子间骨折的有效方法,具有手术时间短、出血量少、患者恢复快、术后并发症少等优势。Objective To discuss the clinical effects of the proximal femoral nail antirotation （PFNA） in treatment of patients with femoral intertrochanteric fracture without traction bed. Methods Fouty - three patients with femoral intertrochanteric fractures were treated with PFNA without traction bed from March 2013 to June 2016. They were 12 males and 31 females, aged from 44 to 93 years （average, 73. 9 years）. According to the AO classification. There were 38 cases of type 31A2 and 5 cases of 31 A3. According to the medified Evans classification. There were 6 cases of type Ⅱ A,8 cases of type Ⅱ B and 29 cases of type Ⅲ.Operative time,intraoperative blood loss, ambulation time, clinical healing time and operative related complications were analyzed. Hip function was evaluated according to the Harris score. Results The operation time was 35 ？86 min （ average, 48 ± 13 min）,the intraoperative blood loss was 50 -80 ml （ average, 87 ±23 ml）. All patients were followed up for 4 to 26 months （ average, 15. 6 months）. The mean time of clinical healing time was ranged from 8 to 15 weeks （average, 10 weeks）. The mean time for complete ambulation time was ranged from 8 to 16 weeks （ average, 12 weeks）. Two patients of deep vein thrombosis were treated in other hospital. No wound infection, hip varus deformity, femoral heed cutout, or nail breakage happened. According to Harris hip rate scale system, The hip function was excellent in 32 cases, good in 9 cases and fair in 2 cases, and the excellent and good rate was 95. 35% （41/43）. Conclusion PFNA was effective in treatment of unstable femoral intertrochanteric fractures, has the advantages of shorter operation time and less blood loss, fast recovery and less postoperative complications.

关 键 词：髋骨折 股骨近端防旋髓内钉 治疗结果 

分 类 号：R274.1[医药卫生—中医骨伤科学]